Main clinical aspects of bipolar disorder: a systematic review of the literature

Abstract

Bipolar disorder (BD) is a chronic and recurrent psychiatric condition characterized by extreme fluctuations in mood, energy, and functionality, affecting approximately 2.4% of the global population. BD manifests through manic, hypomanic, depressive, and mixed episodes, varying in duration and intensity. The disorder significantly impacts patients' mental and physical health, as well as their educational, occupational, and interpersonal functioning. Given its prevalence and associated economic burden, there is an urgent need to improve the clinical management of BD, which is challenging due to its diagnostic complexity, high comorbidity rates, and potential for severe functional impairment. The research focused on analyzing the main clinical aspects of BD through a systematic review of studies published in the last 10 years. Databases such as PubMed and LILACS were used, with inclusion criteria prioritizing relevance to current clinical practice. Studies older than 10 years or without direct applicability were excluded. The review highlighted the importance of integrated clinical management, encompassing pharmacological treatment, psychosocial interventions, and continuous symptom monitoring. Of the 200 articles initially identified, 60 were selected for full reading, and only 6 met the criteria for final analysis. These studies reinforce that BD presents mood episodes that vary in duration and intensity, with depressive episodes being more frequent and longer-lasting than manic or hypomanic ones. Diagnosis and management are complicated by variations such as rapid cycling and frequent symptom changes, especially in children, where symptoms can present in a more complex manner. Studies on pharmacological interventions and continuous monitoring suggest that more frequent mood assessments can improve BD management. The chronic and progressive nature of BD, particularly when inadequately treated, can lead to neuroprogression and premature aging, underscoring the need for early and personalized interventions. The view of BD as an accelerated aging process opens new perspectives for research and interventions, including pharmacological and non-pharmacological approaches that may slow this process. Furthermore, identifying cognitive and emotional deficits in BD is crucial for developing new therapeutic strategies. This analysis underlines the importance of understanding the clinical aspects of bipolar disorder for multidisciplinary and continuous management, as well as improving clinical outcomes and the quality of life for patients with BD.